SECTION 2
SAMPLE N-400 FTT,TNG, USCIS NOTICES, & CORRESPONDENDCE * Sample Naturalization Filing (Blank forms available at http://www.uscis.gov) * Sample Introduction Letter to Client
* Sample ?Filed Case" Letter to Client * USCIS Filing Fee Receipt * USCIS Fingerprint Appointment Notification
* Sample "Fingerprint Appointment? Letter to Client * FormAR-11,ChangeofAddressform * Sample Change of Address Letter to USCIS * USCIS Interview Notice
* Copy of ?Interview Notice? Letter to Client * USCIS Interview Summary * Sample ?Oath Notice? Letter to Client * Form N-445, Notice of Naturalization Oath Ceremony * Sample ?Closing Letter? to Client *
Certificate of Naturalization
3psry€ riune J:m?uary 19, 20? ]
e(b'up bc
U. S. Citizenship and lrnmigration Services p.o. Box 21251
ULC-?'X ?i'(e,
Phoenix, AZ 85036
i Cotceci-4- d'?s
AITN:
N-400
APPLICATION FOR NATURALIZATION
*FEE WAIVER REQUEST ENCLOSED* RE:
iCL{ENT NAME? A#[]
Dear Sir/Madam:
Our office represents the applicant in this N-400 Application for Natura?ization. [APPLICANT] has been a Lawful Permanent Resident since [DATE] and wishes to become a U.S. citizen. Please note that we are filing a fee waiver requesl with lhis app?ication. Enclosed please find the following documents in support of the app]ication: [1 []
Forrn G-28 Notice of Appearance; Form 'i-912 Request for Fee Waiver:
o Statement from Rarnsey County Human Services showing monthly €
[] [1
amount receiver3 in food supporl. Two passport style photographs; Forrn N-400 Application for Natura?ization; and Copy of front and back of permanent resident card.
Thank you for your carefu? attention to this matter. Sincerely,
YOUR NAME TITLE
Cc: APPLICAJSJT
DHS
Notice of Entry of Appearance as Attorney or Accredited Representative
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Form G-28 OMB No. 1615-0105
Expires 02/29/2016
Department of Homeland Security
Part 1. Information About Attorney or Accredited Representative
Part 2. Eligibility Information For Attorney or
Name and Address of Attorney or Accredited Representative
(Check applicable items(s) below)
Accredited Representative
l.a. F(LamasitlNyaNmame)e r l.b.
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Given Name '? .
iAnne
(Fxrst Name) I
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l.c. MiddleName lMoira
1, [X I am an attorney eligible to practice law in, and a member in good standing of, the bar of the highest court(s) of the following State(s), possession(s), territory(ies), commonwealth(s), or the District of Columbia.
I?rranigrant
l.b. {(chooseone) [x amnot 0 am
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Law Center of MN
subject to any order of any court or administrative agency disbarring, suspending, enjoining, restraining, or otherwise restricting me in the practice of law. (If you are subject to any order(s), explain fully in the space below.)
3. Name of Law Student or Law Graduate
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4- State Bar Number 4
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2. Name of Law Firm or Recognized Organization
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Street Number 14 s 0
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Street I iNorth Name i
Justice, Board of Immigration Appeals pursuant to 8 CFR 292.2. Provide the name of the organization
and the expiration date of accreditation.
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state 3 5.f. zip code m
2.a. Name of Recognized Organization
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5.g. Postal Code
qualified nonprofit religious, charitable, social service, or similar organization estab)ished in the United States, so recognized by the Department of
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5.d. CityorTown
0 I am an accredited representative of the following
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Syndicate Street
5.c. Apt. € Ste. [X
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5.h. Province 5.i.
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3.a.
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the attorney or accredited representative of record who previously filed Form G-28 in this case, and my appearance as an attorney or accredited representative is at his or her request. If you check this item, also complete number 1 (l.a. - l.b.l.) or number 2 (2.a. - 2.b.) in Part 2 (whichever is appropriate).
7. E-Mail Address of Attorney or Accredited Representative
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Country
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4, 0 I am a ?aw student or law graduate working under the direct supervision of the attorney or accredited representative of record on this form in accordance with the requirements in 8 CFR 292.1(a)(2)(iv). r
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Form G-28 02/28/13 N
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art 3. Notice of Appearance as Attorney or
7. Provide A-Number and/or Receipt Number
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*
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Accredited Representatiye This appearance relates to immigration matters before
Pursuant to the Privacy Act of 1974 and DHS po)icy, I hereby
(select one):
consent to the disclosure to the named Attorney or Accredited
1. [X USCIS - List the form number(s)
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Representative of any record pertaining to me that appears in
)
N-400
any system of records of USCIS, ICE, or CBP.
8.a. Signature of Applicant, Petitioner, or Respondent
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entered
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0 ICE - List the specific matter in which appearance is
2.
(mm/dd/)FJJ) > 05
s.b. Date
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2.a.
0 CBP - List the specific matter in which appearance is
Part 4. Signature of Attorney or Accredited
entered
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3.a.
I hereby enter my appearance as attorney or accredited representative at the request of:
Representative I have read and understand the regulations and conditions contained in 8 CFR 103.2 and 292 governing appearances and representation before the Deparhnent of Homeland Security. I declare under penalty of per3ury under the laws of the United States that the inforyati,on I have provide% this form is true
E2:',::.:2:',
4, Selectonlyone: [X App)icant 0 Petitioner
and correct.
0 Respondent (ICE, CBP)
1. sj
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Name of Applicant, Petitioner, or Respondent
5.a. Family Name 4
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"(L"as;N'ame) - !
5.b. GivenName %
ey olcc4j?)Reppsentative
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(First Name) l' (F irsl Name)
5.c. MiddleName FJone
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2. Signature of Law Student or Law Graduate
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(mmiaaiyyyy) >j 6tQ,)A(,(3 1 1 4dditional Information 3. Date
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5.d. Name of Company or Organization, if applicable
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NOTE: Provide the mailing address of Petitioner, Applicant,or Respondent and not the address of the attorney or accredited representative, except when a safe mauing address is permitted on an application or petition filed with Form G-28.
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and Name
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6.c. City or Town 6.d. State
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Request for Fee Waiver
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USCIS Form I-912
Department of Homeland Security U.S. Citizenship and Immigration Services
OMB No. 1615-0116
Expires 05/31/2015
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>Before you fill out this form, please read the instructions.
ection 1. Information About You (Provxde mformatxon about yourself Ifyou 11 re applymg for a mmor chdd, provide information about the minor child.)
FOR USCIS USE ONLY Application Receipted At (check only one box): USCIS Field Office
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Line 1. b. Given Name (First Name)
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None
Date:
gFee Waiver Denied
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Line 1. c. Middle Initial
[lFee Waiver Approved
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Line 1. a. Family Name (Last Name)
Line 2. Alien Registration Number
Date:
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(mm/dd/yyyy) rllr
Line 3. Date of Birth
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USCIS Service Center
Fee Waiver Approved
Line 4. Marital Status [X Never Married 0 Divorced [1 Marriage Annulled gMarried
Date:
[]Widow(er) [] Legally Separated
gFee Waiver Denied
Line s. Applications and Petitions (Enter the form number(s) of the application(s) and/or petition(s) for which you are requesting a fee waiver.)
Date:
Biometrics services fees, where applicable, will be included in the fee miver request.
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N-400
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Section 2 Addihonal Information for Dependent(s) Line6. Comp}etetheTablebelovvifapplicable.(Ifyouneedmorespace,attachaseparatesheetofpaper.) A-Number
Name (First, MI, Last)
(If applicable)
Is Individual
Date of Birth
Included in Fee
(mm/ddlmy)
Relationship to You
Waiver Request?
Form I-912 05/10/13 Y
A-
gYes g No
A-
gYes g No
A-
gYes g No
A-
g Yes g No
A-
g Yes [1 No
A-
g Yes 0 No
A-
g Yes g No
Page l of s
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Section 3. Basis for Your Request (Check any that apply. For additional information, see the form instructions. ) Line 7. a. [X I am or a relevant member of my household is currently receiving a means-tested bene'fit. (Complete Sections 4 and 7.) Line7.b. [] Myhouseholdincomeisatorbelowl50%oftheFederalPovertyGuidelines.(Comp/eveSecffons5and7.) Line 7. c. 0 l have a financial hardship. (Complete Sections s, 6 and 7.) A
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ISection 4 Means-Tested Benefit W
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[iB6 g, Complete the Table Below (If you need more space, attach a separate sheet of paper.) Name of Person
Receiving the Benefit
Name of Agency Awarding Benefit Ramsey County Human Services
Date Benefit
Is This Benefit Being
Wgs Awarded
Received NOW?
01/01/2010
[XYes g No gYes g No [lYes g No gYes g No gYes [] No gYes g No gYes 0 No gYes [1 No
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Section s Household Income (Provxde evxdence ofmonthly mcome or other support ) Line 9. Other than you, how many others in your household depend on the stated income?
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Line 10. Average monthly wage income from household members
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(round to the nearest dollar)
Line 11. Enter other money received each month that is not included in Line 14. (This could include spousal support, child support, unemployment, etc.)
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TOTAL (USCIS will compare this amount to Federal Poverty Guidelines)
Form I-912 05/10/13 Y
Page 2 of s
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Sectxon 6 Fmancial Hardshxp
Line 12. i Describe your particular situation. Be sure to include how this situation has caused you to incur costs (and what the costs vvere) or loss of income that you have experienced (and what that loss was). Complete this section in English; otherwise, provide an accompanying English translation. (ffyou need more space, attach a separate sheet of paper.)
If you are currently unemployed, you must complete Lines 13 and 14.
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(mm/dd/yyyy) r I Linel4. Amountofunemploymentcompensation(monthly)thatyouarereceiving(enterdollars) j
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Ljne 13- Date that you became unemployed
Line 15. List your assets and the value of your assets. (If you need more space, attach a separate sheet of paper.) Type of Asset
Fomi I-912 05/10/13 Y
Value (enter dollars)
Page 3 of s
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Section 6 Financial Hardshtp (Com'd) Line 16. List your average monthly costs, and provide evidence of monthly payments where possible. (.[f you need more space, attach a separate sheet ofpaper.) Value (Enter Dollars)
Type of Cost
Value (Enter Dollars)
Type of Cost
Rent
Loan Payment
Mortgage
Commuting Costs
Food
Medical
{Jtilities
School
Child/Elder Care
Other Expenses
Insurance
TOTAL Monthly Costs
Sechon 7 Your Signature and Authorua'bon Do not sign your Form I-912 until it is complete and you are ready to file.
I take full responsibility for the accuracy of all the information provided, including all supporting documentation. I authorize the release of any information, inc)uding the release of my Federal tax returns, that USCIS needs to determine my eligibility. Each person applying for a fee waiver request must sign Form I-912. This includes individuals identified in Sections l and 2 if 14 yeys of age or older. (If you need more space, attach a separate sheet of paper.)
Printed Name
Line 17.1.
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Additional Signature j
lDate (mrn/dd/yyyy) k C
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Your Signature [J l
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lDate (mm/dd/yyyy) r l
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Printed Name
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Line 17.
Line 17.2. Additional Signature l
Line 17.3. Additional Signature j Printed Name
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lDate (mm/dd/yyyy) rl
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Line 17.4. Additional Signaturel l
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Printed Name
lDate (mrrJdd/yyyy) >l
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Printed Name
lDate (mrn/dd/yyyy) >I
Form I-912 05/10/13 Y
Page 4 of s
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ISection 7. Your Signature and Authorization (continued) Line 17.5. Additional Signature j
lDate (mm/dd/yyyy) >l
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lDate (mm/dd/yyyy) rl
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Printed Name
Line 17.6. Additional Signature j Printed Name
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lDate (mm/dd/yyyy) r j
Line 17.7. Additional Signaturel
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Printed Name
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Form I-912 05/10/13 Y
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P" C!)---i v?
? RAMSEY COUNTY HUMAN SERVICES
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160 KEILDGG BLVD E
ST. PAUL MN 55101-1420
December 07, 2010 lD'i58 AM CASE NUMBER: 4
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SAINT PAUL MN @
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?MPORTANT JNFORMATION REGARD?NG THIS DOCUMENT: * This information is avajlable in other forms to people with disabilities by calling >iour county worker, at (651) f
266-3982.
* For TTY/TDD users, contact your county worker through the Minnesota Relay at 711 or (800) 627-3529. For the Speech-to-Speech Relay, call (877) 627-3848.
* The back of this page lists your appeal rights and responsibilities. MFIP NO11CE OF DE(:?S?ON
The following change(s) did not affect your MFIP grant for January 2011: We received your Household Report Form. You will get 1805.00. (Auth:7,17,20,24)
Your grant includes a food portion of *473.00. (Auth:22.12) BUDGET FOR JANUARY BENEFIT
HOUSEHOLD S?ZE (3)
F,e=e- - 'tt-kVe(December 07, 20?0 10:58 AM Case Number:
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FAMILY WAGE LEVEL NET EARNED INC:OME DIFFERENCE
Page 2
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* 1106.00
GRANT AMOUNT
*
805.00
*
PRORATED GRANT AMT. .0
0.Dp
0.00
.* 1106.00
NET DEEMED INCDME. (-)* TRIBAL (.OUNTED lNC.(-)* SUBSIDY/TR]BAL..(-)*
0.00
SANU}jONS OX. .
AMT ALREADY ISSUED . * SUPPIEMENT . . . . . * OVERPAYMENT . . . (-)* ADJUSTEI) GRANT AMT. .* RECOUPMENT AMOUNT (-)* FOOD JSSUANCE . . . e STATE FOOD BENEF}T. -s
0.00
CASH ISSUANC.E
TRANSJT?ONAL STANDARD.* 1005.00 MONTHLY NEED . . . . .* 1005.00 UNEARNED INCOME . .(-)* 200.00
(-)*
0.00
0.00
FOOD PDRTION . . . . .* 473.00
.*
0.00 0.00 0.00 805.00 o.oo 473.00 r),On 332.00
. TDTAL GROS.S .lNCO.ME is *200..0.0' thi?i .:'o?ntti'.'? lf? ?y.opr '70TAt *RDSS 1N€:OME , wil? be less than 00.00 in JANUARY, call your'worker right away. ***** ?MPORTANT APPEA? RIC;HTS! READ THIS NDW! *****
If you don't agree with the action taken on your case, you can appeal. To keep your benefits until the appeal, you must appeal: 31 Within 10 days or
* Before the first day of the month when the action takes place.
If you m5ss the 10 day deadline, you can appeal within 30 days from the date you get this notice (90 days for Food Support), but your benefits will not start again unless you win the appeal. To find out more, read the back of {he first page of this notice.
WORKER: J
4
TELEPHONE: (651) 266-3982
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Application For Naturalization
USCIS Form N-400
Deparlmenl or Honieland Security u.s. Citizenship and linmigration Serviccs
OMII No. 1615-0052
Expires 09/30/20 15
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Receipl
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For
USCIS Use
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Type or print all your anssvers in black ink. Type or print "N/A" iran item is not applicable or the answer is "iione' unless othenvise indicated. Failure Io anssver all oftlic questions may delay USCIS processing your Form N-400. NOTE: l'ou must complele Parls 1. - 14.
Parl 1. lnformalion About Your Eltgibility (C]ieck only one box or yoiw Form N-400 iiiay be delayed)
Enter Your 9 Digit A-Number: >A-
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You are at least 18 ycars old and
1. [x Have bccn a Pemianem Residcnt or the Uniied Staies ror art least s years. 2. 0 Have bcen a Pcrmanem Rcsidciii or the Uniicd Stalcs ror art Icasi 3 ycars. In addition, you havc bcen married to and living with the same u.s. citizen spousc ror ilie last 3 years, and yoiir spouse has bccii a u.s. citizen ror thc Iast 3 years at the time of filing yosir Fomi N-400. 3.
[] Are a Pennanent Rcsident or the Uniicd States. and you arc ilic spouse or a u.s. citizcn, and your u.s. citizen spouse is regularly cngaged in specified employmcnt abroad. (.Seciioii 3 / 9(b) of dze lminigrmioii and .S'aiionalii.so .-lci)
4.
g Are applying on the basis ofqualifying military scrvicc.
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@ Other(explain):(
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Part 2. Information About You (Persoii applying for naiiirali=ation) I. YourCurrentlegalNsme(doiiotprorideanicknanie) Family Name (].tist :S'aine)
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Gisien Nnmc (la'irsl iVanie)
Middle Namc (ifapplicable)
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2. Your Name Exactly As 14 Appears on Yoiir Permanenl Resident Card (ifapplicable)
Family Name (].usi Ntziiie)
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Givcn Name (Fir.si A'ame)
10
Middle Nainc (4fa(2plicable)
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3. OtherName{s)YouNaveUsedSinceBiiih(inclirdenicknuiiies.uliases.andiiiaidennaiiieifapplicable) Family Namc (l.asi iS'time)
Givcn Name (la'iisi A'ame)
Middle Namc (4fapplicable)
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Part 2. Information About You (coiiliiwed) 4.
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Name Change (oplional) Read the Form N-400 Instructions berore you decide whether or nol yon woukl like to Iegally change your name.
[X Yes g No
Would you Iikc lo legally change your namc?
//'J'e.s;," print lhe iiesv name yon ivonld like lo rise iii lhe space beloui. Family Name (Lasl A'aine) Given Narne (l'irsl A!aine)
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s. U.S. Social Security Number (if app/ictible)
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6. Date or Birth 1
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7. Date You Became a Permanenl Residem
(iniwdd)yiy) 11
M idd le Name (if aplilicuble)
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9. Country ofCitizenship or Nationality
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10. Areyourequestinganaccommoibilion(s)totlienaturalizationprocessbecnuseofiidisiibilityand/or n n im pa }rm ent? (See Foiin N-400 lnsmciioihsfiir uccoiiiinodaliois eminples)
0 Yes [X No
17"Yes," check the box(es) belosv dzm alililies.'
0 Deaf or hard or hearing and need air imerpreier who uses the rollowing sign languagc (e.g., Amcrican Sign Language):
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[0 Use a wheelchair or other device that assists ivith mobility. g Blind or losv iaision.
[] Require another t;ype of acconiinodaiion. (cxplain):
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11. DoyouhaveaphysicalordeveloHimentiildisnbilityormentalimpairmentthnipreventsyoiifrom [] Yes [X No demonstrating your knowledge imd undersliumlng of the English languiige and/or civics requirements ror nnturalizii€ion?
lf" }aes," submit a coiiipleied Forni N-648, kledicul Ceriiftcation for Disabiliiy Ext'epiions. when you file yoiw Foriii A'-400. 12. Exemptions from lhe English Langunge Test
A. Arc you 50 years of age or older and havc you lived in the Uniied States as a Permancm Residem for 0 Yes [X No pcriods totaling at least 20 years art ihc iimc or filing your Form N-400?
B. Are you 55 years of age or oldcr and havc you lived in the United Statcs as a Pcrmancnt Resident for 0 Ycs [x No pcriods totaling at least 15 ycars at thc time or filing your Form N-400?
C. Arc you 65 years or age or oldcr rind have you Iived in the United States as a Pcrmancm Rcsideni ror 0 Ycs [x No pcriods totaling at least 20 ycars art the iimc or riling your Form N-400? (lfyoii iiieei this reqiiiremem, yon will alw be given a simp/ified version qflhe civics lesl.)
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" ='m'i'ie'ff " :ff'=ffi'f??a 4. Mobile Phon?eNumber (fany) s. E-miiil Address (iftii6r) r I!..
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[ Part 4. Information About Your Residence
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1, Where liaiae you Iived during the last s yeiirs? Bcgiii with svhcrc you live nosv and then list evcry Iocaiion svhere you have lived during the last s years. Jfyou need more space. use tin additional sheet(s) oT paper.
DatcorResidence Fmm(mniidd2i)yi) >?03/02/2013 r
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Wrmmion About Your Residence (coiitinueti) 2. Dale of Rcsidence
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[ Part s. Information About Your Parents
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If your biological or legally mlopttve mother or father is }l U.S. cilizen by birlli, or iiiituralized berore you reached your ] 8th
binhday, you may already be a U.S. citizen. Visii the USC 15 Web site art ssaivsv,usc!s,'pov ror ruriher inrormation on this topic berore you consider filing Form N-400. 1. 1l'ereyourparentsmarriedbeforeyourl81hbirthd:iy?
[x Ycs [] No
2. Is your molher a u.s. citizen?
g Ycs [X No
!/")"cs," coinplele lhe follosving irforinatioii.
A. Current Legnl Name or U.S. Citizen Molher Molhcr's Given Name (l'irsl Nmiie) Molher's Middle Nanre (iftipplicable) Mother's Family Namc (l-avt Naine)
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(, Mother's Date or Birth (iiiinldd'.s5559
B. Mother's Country or Binh
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0 'i'cs [X No
3. Is your rather a U.S. cilizen?
!f"Yes," coinplele lhe inforiiialiois belosr. A. Current Legal Nnme or u.s. Citizen Father Fatlicr's Given Name (Firsl A'aiiie) Fa(her's Middle Namc (ifapplicable) Father's Farnily Nanic (l.ad Name)
]
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(:, Father's Dalc of Birth (iiiiii-'dd555y)
B. Falher's Country of Birlh
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gart b. lnrormalion ror Criminal Records Check NOTE: USC 15 requires you to complete the categories bclow to conduct background cliccks. (,';ee l'orin N-400 lnstrsictions for more infoiiimioii) 1.
Gender [X Male 0 Fcmale 2. Height Fcct D Inches 0
3. [thnicity (Seled one)
[0 Hispanic or Latino [x Not Hispanic or Latino 4. Race (seleci one or inore)
g Amcricanlndian 0 NntivcHawaiianor
g lVliite [x Asirin [1 Blackor African Americaii
or Alaska Native
Otlicr Pricific Islander
s. llair color
[X Black 0 Brown [] Blonde [] Gray [] 11"hite [0 Red 0 Sandy 0 Bald(Nohair)
11
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01
1 i FomiNAOO 09/13/13 N
1 l'age s or 21
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1-14
%b. ] nformation ror Criminal Records Check (contiimeti) Eye eokor
6.
[1 Brmvn 0 Bluc 0 Grccn [1 llazel 0 Gray [X Black [] Pink g Maroon 0 0ther
l
S7. Information About Your Employmcnt and Scl*ools You Attcnded List where you hsve worked or attended school full lime or part time during the last s years. Provide informalion for the complete rime period. lncludc all military, police, and/or intelligencc servicc. Begin by providing information about your most reccni or currcnt employrncnt, studics, or unemployment (4fulililicoble). Proiiide thc locations and datcs where you worked, sverc selr-cmployed, svere unemployed, or have studied ror the Iasi s years. If you worked ror yoursclr. svritc "sclf-employed." lfa you svere unemployed, write "unemployed.' If you need more space, use an iidditional sheet(s) of Hi:iper to complete Part 7. Ernp!oyer or School Name
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Apl. Sle. Flr. Number
Street Number and Name
la a a€
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ll Slale
Cily
Poslal Codc (foreign address onl))
Country (ftweign address oidy)
Pmvince or Region (foreign address otd)i
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Date To (iniivMlsp>>:) >102/17/2014
Date Fmm (min-odd'>yyy) >009/23/2013 (
2.
Z!P Code + 4
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Your Occupatioii
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Employer or School Name
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Strcet Number and Name
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Ap(. S(e. Flr. Number
la a affi
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'ps
City
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ZIP Code + 4
i?>-a
Austin
Provincc or Region (forciyn address oidy)
Coun}ry (foreiyii address oid)}
Posial Codc (foreign address only)
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)>106/13/-2013
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Yoiir Occiipalion
Dale To (mm/dd/yyyy)
Date From (mm/ddiy)yy)
> J12/28/2012
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Part 7. }nformation About Your Employment and Schools You Attended (conlinued)
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A-144
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3. Employer or School Namc
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11
S}reet Number and Name
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Apt. Stc. Flr. Number
la a a[]
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City
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ZIP Code + 4
Statc
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Sainc Paui
l'rovince or Region (foreigii udtkess oid)) Counlry (foreigii tiddress oiil.si)
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Drile From (mm'da5yyy) Datc To (imii.-M/B5y)
>103/28/2013 r
>103/29/2013
Postal Codc (foreign address only)
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USA
Your Occupation
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1
r Part 8. Time Oulside the United States l Howmanytotaldays(24hoursorloiiger)didyouspendoutsidctlicUiiitcdStatesduringtlielast5years? 2. How many trips or 24 hours or longer have you taken outsidc the United States during the last s ycars'?
[=0 ldays ffitrips
3. Listbelowallthetripsof24hoursorlongerthaiyouhnvcinkciioiiisidcthcUnitcdStaiesduringtliclast5years. Bcgin with your most rccent Irip and work backwards. Jr you nced snore space, use an additional shee€(s) or paper.
Dat;-You Left the United States
Date You Returned
Countriesto --'-'-
Did Trip Lnst 6
to the United States Alonths or Alore?
(inin/dd5yyy)
l
(iisiiMd!my)
Total Days Outside the United States
l%'hich You Traveled
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I FormN-400 09/13713 N
11
iii
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ta
l l'age 7 or 21
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l-(m
Wrmation Aboul your Marital History
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1. Whal is your current marilnl slstlus?
[XSingle, ncvcr married [] Marricd 0 Separatcd 0 Divorced [0 lVidowed 0 Marriage annulled [] Yes g No
2. }fyouaremarriedlisyourspouseacurrentmemberoflheU.S.ArmedForces?
3. Nosvmanyt5mcshuvcyoubecnmnrried(incliidingaiwuillednsarriagesandntarriuge(s)tozhesameperson)?
[=
lf):ori are siiigle arid husv never been iiiarried. iiidicate "0" and go to Pan 10. 4. lfyouaremiirriednow,providethefollowinginformationaboutyourcurrentspouse. A. LegalNameorCurrenlSpouse
Family Nainc (l.tist iS'tniie)
Middle Nainc (ifupplicable)
Givcn Naine (First iVame)
11
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B. PreviousLcgiilNiimeorCurrentSpoiise
Middle Namc (i/ tipplicable)
Given Nanie (Firsl ,"'aiiie)
Fami ly Namc (l.ri.s;t A'tiitw)
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C. Otlier Niinscs Llsed liy Current Spousc {inclzide nicknames, aliases, and nsaiden nmne, ifapplicable} Family Name (l.ast A'tiiiie)
Middle Namc (if aplilicable)
Given Naine (First ,Sraine)
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E. Dale l'ou Emered into Marringe willi Currenl Spouse
D. Current Spouse's Dale or Birtli
l (miiv'dd/)yy)r) >(
(miir/dd/.1')?)?J) > I
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F. Currcnt Spouse's Present llome Mdress
Apt. Ste. Flr. Numbcr
Street Numbcr and Namc
la a a[]
r County
City
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Pmvincc or Rcgion (joreign tzddress oiil?l) Country (foreip,n address oniv)
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State
ZIP Code + 4
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Postal Codc (foreigii address oid)}
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G. Current Spouse's Presenl Employer
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s. Is your current spouse a u.s. citizen? lf"Yes," ans'iver Itein r'Viiiiiber 6. lf"No," go to Item Niimber 7.
MiiMl ! I I&A 1 Form N-400 09/13/13 N
I'iige)l
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Part 9. Information About Your Marital History (conlinued)
'al
11
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6. lfyourcurrentspouseisaU.S.citizen,completetherollowinginformation.
il. Wlien did your current spouse become n t.i.s. citizen?
0 Mbinh-GoioltemNimiber8. [lOihcr-(aompleiethefollossainginformaiioii. B. DateyourcurrenlspousebecamenU.S.citizeii (iiiinr'dti/yyyy) k
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7. If your current spouse is not a U.S. cifizen, cnmplete the rollowing information. /1. Current Spoiise's Country ofCilizenship or Nntionality
B. Currenl Spouse's zi-Number (ifapplicable)
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C. Current Spouse's Immigration Status
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0pcmianent Resideni 0 0ther (explaiii):l 8- Howmany€imcshasyourcurrentspousebeenmarried(iiit4udinHamiiilledmarriagesniidiiiarritige(s) to the same persoiifi l r your current spouse has becn married beforc, provide the rollowing inrorrnation about your currcnt spouse's prior spouse.
[5
If your current spouse has had more lliaii one previous miirriage, use an additional slieet(s) or paper lo provide the informntion requested in Items A. - H. below ror eneli iunrrisige.
A. Prior Spousc's Family Name (Lasl A'aiiie) Given Niime (Firsl tS'aine)
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(11 iddle Nsmie (ifa(?plicable)
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B. Prior Spouse's Immigration Slatus
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[) U.S.Citizen 0 PermanentRcsidcnt [] Other(cxplain)f D. Prior Spouse's Counlry or Birth
C. Prior Spouse's Date of Birth
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(iiiin'dd'3ryy)9 k ! E. Prior Spouse's Country of Citizenship or Nnliomtlity
]
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G. Date Marr?age Ended wilh Pr!or Spouse
F. Dale or Marriage with Prior Spouse
(iisi>Jdti/y)r)r)z) k (
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(iniii/ddr'y)5y) k (
H. llow Marriuge Ended with Prior Spouse
]
0Annullcd 0 Divorced [] Spotise Dcccascd [?] Ollier (explain):l
'mii 1 Form NAOO 09/13/13 N
11111111111111111111111111
i miaib.ti.ipi
Page9or21
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4
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%9. lnrormation About Your Marital Hfstory (coiitiimed)
I-C
Th
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9. lfyouwcrcmarricdberorc,pmvidethefollowinginformationabou5aourpriorspouse.lfyouhaiaemorethanoneprevious marriage, use an imditional sheet(s) of paper to provide the informatfon requested in Items iS. - H. below for each marri;ige. A. Your Prior Spouse's Family Name (Lasl :';ame) Given Name (Fir.s;I Naiiie)
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Middle Name (4fa(yilicable)
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B. Your Prior Spouse's Immigration Status When Your Marringe Ended
0 U.S.Cilizcn [1 PcrmanenlResident 0 0thcr(explain):( C. Your Prior Spouse's Date of Birlh
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D. Your Prior Spouse's Country or Birth
(niiiildtUyv)y) > (
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E. 1'ourPriorSpouse'sCountryofCitizenshiporNationiility
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F. Date or Miirriage with four Prior Spouse
G. Diile Miirriage Ended with Your Prior Spouse
(isiiii/dd5y)iv) k (
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(min/dd'y)yry) k l
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11. llow Marriage Ended with l"our Prior Spouse
0Annullcd 0Divorced [)SpouseDeceased []0thcr(cxplain):(
l
r Part 10. lnrormation About Your Children
l
[2
1. lndicntcyourtotnlnumberorchildren.(Mlchildrenshorddbeindicaled,inc/iiding:.-l.Cliildreiiwhoarealive. missing. dcceased: B. ( izildren born in the Uniied Staies or iii other comitries: C. Cliildren undcr 18 years o/ age
or older: /). ( liildrcn si4io are currenlly married or immurried: E. ( iii/dren liviiiy, widi y01/ or elsevhere,' /'. ( oiirreiit siepcliildreii.' G. l.e;galiv udopied cliildren; and //. Childreii borir when yon were /}0/ iiiarried )
2. PmvidelhefoII0winginformationaboulsillyourchildren(somzmz/zJ!oiig/i/ers)listedinltemNumberl,,regardlessorage. Use nn iiddition:il shee((s) or paper to list any additionnl children. A.l.Child's Curreiit Legal Name Family Namc (Ltisi ,'Vaiiie)
Givcn Naine (Fir.sl Name)
('r
][
Middlc Name (fapplicable)
][
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A.2.Chird's it-Niimber (ifapplicable)
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A.3.Child's Dute or Bir€h
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(iiriiiltkt')yy) k (
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A.4.Child's Country or Birih
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1 l Form N-400 09/13/13 N
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Part 10. lnrormation About Your Children (continued)
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A.5.Child's Curren€ Address Streel Niimber and Name
Apt, Sic, Flr. Numbcr
la a affi
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State
Coiinly
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Pmvince or Region (foreigis uddre.s;s oid)) Country (foreigii
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ZIP Codc + 4
Postal Code (foreigii
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A.6.SVhatisyourch5?d'srelationshipsoyou'!{e.g..biologicalchild.sie(xliild. l l-hnidlvntinn*otirhi/tli le(,ally adopted chi/4)
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B.lChild's Current Legal Name Family Name (Last A'aiiie)
Given Name (Firsl A'tiiiie)
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Middle Name (ifa(2plicable)
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B.2. Chifd's A-Number (if applictible)
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B.3. Child's Da€e or Birth
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(mniodtl:)i)ry) kl
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B.4. Child's country or Birth
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Apt. Slc. Flr. Number
Street Number and Nanie
l city
Stalc
County
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'l[-€
Postal Code (foreigii address onl))
Pmvince or Region (forei;gii ciddress only) Coumry (foreigii address oiily)
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ZIP Codc + 4
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B.6.SS'hatisyourchi}d'srelationshiptoyou?(e.g.,biologicalchild.siept4hild, l bhryziisiiyitsriintirhiitzi legall.si adopted child)
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11 l Fomi NAOO 09/13/13 N
Piigc 11 ola21
I
1-fi
lPart 10. Information A?bout Your Children (contiiiued) C.lChikl's Current Legal Name Family Name (Lasl Name)
Givcn Name (l'irst A'aine)
C.2.Child's A-Number (ifapplicable)
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Middlc Name (ifapplicable)
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C.3.Cliild's Date of Birth
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C.4.Child's Couiitry of Birth
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C.5.Child's Currenl zlddress Slrcet Numbcr and Name
Apl. ste. Flr. Number
la a am
r City
Counly
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State
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tm-[?]
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Pmvincc or Region (foreign address nid)) Coiintry (foreiyii uddress oid))
Poslal Codc (foreigii uddress onl))
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C.6.WhatEsyourchild'srclat!onshiptoyou?(e.H.,biologicalchild.slepchild, l lriotdhinilnnlt>tlrhilrh Iegall)i adopled child)
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D.l.C}iild's Ciirrent Legal Nnme Family Nanic (Lasl iS'ame)
Givcn Narne (Firsl Naine)
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Middlc Namc (4fapplicable)
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D.2.Chim's A-Number (ifapplicable)
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D.3.Cliild's Dale or Birlh
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D.4.Child's Country of Birth
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D-5.Child's Current Address S{rccl Number and Namc
Apt. Ste. Flr. Number
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City
Count;y
(
Statc
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Pmvince or Rcgion (foreign address oidy) Cotinlry (foreiHn adt/ress oidy)
r
ZIP Codc + 4
l € - €
Postal Code (foreiHn uddress only)
ir
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D.6.ll'hat is your child's rclationship lo you? (e.y.. biological clii/d, siepchiId ( lrhoiillsintlnnzptlrahijilj legull)i adopted cliild)
)11:fl:I,Mili Vlma!'lJllliMl Forni N-4€H) 09/13/13 N
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I I'agc 12or21
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% . Additionnl Information
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Anssver Item Numbers 1. - 21. lfyou answer "Yes" lo any or these qiiestions, include a written explanalion on an imditional sheet(s) or paper and provide any evidence €o support your answer. 1. Have you ever claimed to be a u.s. cilizeii (iis writing or (/l!11 odier irtz.i)'.
g Ycs [x No
2. Have you ever rcgislcrcd to Vote in any Federal, State, or local clcclion in ilie United Siaics?
g Yes [X No
3. l-lave you ever voted iii any Fedeml, Stale, or Iocal eleclion in Ihc Uniled Slalcs?
g Yes [X No
4. Do you now have, or did you ever have, a lierediiary title or an ordcr ofnobility in any forcign coumry?
g Yes [X No
s. Have you ever becn dcclared Iegally iiicompeient. or been confiiicd to a mcnial instiiuiion?
g 'i'es [x No
6. Do you osvc any overdue Fcderal, Stale, or locnl taxes?
€ Yes [X NO
7. A. Have you ever nos filed a Fedcral, Sisitc. or Iocal sa.x reium siiicc you became a Pcrmiiiicnt Resident?
g Yes [x No g Yes [x No
B. lf"}'es."didyouconsideryourselftobca"non-U.S.residem"?
[] Yes [x No
8. Have you called yourself a 'non-U.S. residcm' on a Federal, Staic. or local ta.x retuni since you became a Permanent Resident?
9. A. Have you ever been a member or, involved in, or in airy way associaled with, nny organization, association, rund. foundation, parry, club, society, or simimr grotip iii the United Staies or in any othcr
[X Yes [1 No
location in thc svorld'!
B. If "}aes," providc ilie information bclow. Er you need more sBiiice, attaeh the names or the other group(s) on an additional sheet(s) or paper and provide any evidencc to suppon your answer.
" %B(HeorGroup
' Data of Membersh!
Purpose oT the Grou'p
From
(mmldd/yyyy)
WCathOliC ChurCh
To worship with ot.hers
I (mns/@mry)
02/01/2013 02/10/2014
:Youth Group
l
I
10. Have you ever bccn a member or, or iii any svay associated (eidwr directl.v or indirecd3:) with: A. The Communisl Parly?
[] Yes [x No
B. Any other totalitririan party?
g Yes [X No
C. A terrorist orgaiiization?
g Ycs [X No
l
&li!V.l il
1 ForinN-400 09/13/13 N
l l'agc 13 of21
l
IPart 11. AdditionaJ lnrormation (conliimed)
l- lj
1
]
0 Ycs [X No
11 ?4avcyouevcradvocated(eiiherdirectisinrindirecd))theoverilirosvoranygovcmmcnsbyrorceor violcnce?
12. Haveyoueverpersecuicd{eiiherdirecilyorindirectly)anypersonbecaiiseorrace,rclig:on,national origin, membership in a panicular social group, or political opinion?
0 Yes [X No
13. Bctween March 23, 1933 and May 8, l 945, did yoti work for or associaic in any svay (eiilier direcd)i or indireclly) with: rS. The Nazi govemmen€ ofGermaiiy?
[1 'i'cs [X No
B- Any government in any area (l )occupied by, (2)allied with, or (3) established iviih the help of thc Nazi government ofGermany?
0 Ycs [X No
C. Any German, Nazi, or s.s. military unit, paramiliiary unit, sclr-dercnse unit, vigilame unit, citizen unit, [] Ycs [x No police unit, government agcncy or omcc, cxicrmination camp, conccmraiion camp, prisoner or svar camp, prison, labor camp, or transit camp? 14. Wcrcyoueverinvolvcdinanywaywiihaiiyoriliefollowing: A. Genocidc?
0 Ycs [X No
B. Torlure?
[1 Ycs [X No
C. Killing,ortryingtokill,someonc?
€ Yes [X NO
D. Badly hurting, or trying to hurl, a person on piirpose'!
[] Ycs [X No
E. Forcing, or trying to rorce, somcone to have any kind of sexual coniaci or relaiions?
0 Ycs [X No
F. Not letting someone practicc his or licr religion?
[1 Ycs [X NO
15. Wcrc you ever a member or, or did you ever serve in, help, or othcrwisc panicipalc in, any of the rollowing groups: A. Military unit?
[1 Ycs [X No
B. Paramilitary unit? (a groiip o//x!l)/)/(! who ad like (J mililary groirp !nil ure nol parl oflhe official
0 Ycs [x No
issilitary) C. l)olice unit?
€ Yes [X NO
D. Selr-dercnse unil?
€ Yes [X NO
E- Vigilante unit? (a groiip of people who uci like the police, biii are iioi purt (!/ ilie official po/ice)
0 Ycs [X No
F. Rcbel group?
€ Yes [X NO
G. Gucmilla group? (a group oflieople svlio use wcapom agaiiist or oihenrise pli):vically aiiack the militar): police, government, or odier (xaople)
0 Ycs [X No
ll. Militia? (aii ariiiy of(xople, 170/ p
[] Ycs [X No
t. rnsurgcntorganizmion?(ugroiipiluitirsessveaponsandfighzsagainstagovermiieiig
[] Yes [X No
I
I l I
Fmm N-44)0 09/13/13 N
1
'1 l'iigc 14or21
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Part 11. Additional lnrormation (conliimed)
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A-{4
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16. SVcre you ever a vtorker, volunleer, or soldier, or did you othenvise evcr scrvc in any or the following: A. Prison orjail?
g Yes [X No
B. Prison camp?
[] Yes [x No
C. Detention racil ity? (a pluce where people are forced to siti)i)
[0 Yes [x No
D. Labor camp? (a place ss;here people ureforced /O work)
[] Yes [X No
E. Any other place svhere people svcrc rorced to siay?
g Yes [x No
17. SVcrc you ever a pan of any group. or did you ever help any grotip, unit, or orgaiiizaiion that used a weapon against any person, or threatened to do so? /1. Ir "Y(!S," when you wcre part or this group, or when you hclpcd this group, did you ever use a weapon against another person?
[1 Yes [X No g Yes € No
13. lf")"es,"whenyouwerepariorthisgroup,orwhenyouhelpedthisgroup,didyoueveriellanoihcr € Yes 0 No perion that you would use a wcapon against that person? 18. Did you ever sell, give. or provide wcapons lo any person, or hclp aiioilicr pcrsoii scll, give, or provide weapons to an} person?
g Yes [X No
A. If ")'es," did you know that this pcrsoii svas going to use the weapons against another person'.
g 'i'es [] No
B. lfa "res," did you knosv that this person svas going to sell or givc ihc wcapons to someone svho svas going so use them against anoihcr pcrsoii'!
[1 'i'cs [] No
19. Didyoueverreceiveanyzypeormilii;iry,parammtary(agroiipoflieoplesvlioactlikeamiliiarygrnupbiii [0 Yes [X No are nor part rdthe official itiiliiary), or weapons lraining?
20. Didyoueverrecruit(ask),enlist(signrip),conscripr(reqiiire),oruscanypcrsonunderagel5ioserveui [] Ycs [X No or hclp an anned force or gmup?
21. Did you ever use any person under agc 15 to do anything that )ielped or supported pcoplc in combat?
g Yes [X No
lr any of Item Numbers 22. - 28. apply to you, you must answer " Yes" evcn ir your reccirds have been sealed, expunged, or
othenvise cleared. You must disclosc this inromation cvcn ir anyone, iiicluding a judge, Iasv cnforcemcns orT;ccr. or atiomey, told you that it no longer constitutes a record or told you thai you do not have to disclosc the information.
22. llave you ever committed, assistcd iii committing, or atiempsed to coinmil, a crirnc or offcnse ror which you @ Yes [x No were not arressed'!
23. Havc you ever been arrcstcd, cried, or dctaiiicd by any law enforcemcm omccr (incliiding any arid all (g) Yes @ No immigration offIcials or the l].,';. Arined Fnrces) for any reason?
24. Havc yon ever been charged with coiiimiiting, altempling to commit, or assisting in committing a crime or (J Yes [11 No offcnsc?
25. Havc you ever been conviclcd ora crime or offensc?
[] Yes [x No
26. Havc you ever been placed in an alicmative sentcncing or a rehabiliiative program (e.g., dirersioii, dt
[] 'i'es [X No
J l
111 Fomi N-100 09/13/13 N
Piige 15or21
l-T=
I-Part 11. Additional Information (continued)
]
[] Yes [X No
27. A. Have you ever received a suspcnded senlciicc, bccn placcd on probation, or been pamlcd?
[] Yes 0 No
B. lr"}'es,"haveyoucompleiedthcpmbationorparole?
g Yes [X No
28. A. I-lavc you evcr bccn in jail or prison?
[3. lr")'es,"howlongivereyouinjailorprison?
Years
I? Montlis ffi Days [
29. lr yon ansivered "Yes" to Jtem Numbers 23. - 28., complete the rollowing table- lr you need morc space, use nn ndditional slieei(s) or paper and provide any evidence to supporl your anssver. ff you answcred "J1'0" to tdl Item Numbers 23. - 28., go to Item Number 30.
Why were you Date arres'teN, ci€ed, ll'here were you arresled, cited, detained, or charged.
sirresled, cited,
l deta}ned, or chsirged?
a r res t * c ai t a t k o n y d e t e n t ai o n o r
(Ciiy, State, Country)
charge (no charges filed, charges dismissed, Jail, probatim, ezc. )
S'a-int Paul MN USA
Drivinq withou: a-
5utcome-oi dfsposition orthe
detained, or charged?
(mm.'dd/>>>>')
Dismissed after showing
§2013
license
vali6 drivers licerise
Anssvcr Item Numbers 30. - 46. If you answer "}'es" to any of these questions, except Item Numbers 37. and 38., include a written explanation on an additional sheet(s) oT paper nnd lirovide any evidence to support your anssver. 30. Havc you ever: A. Been a habil?ial drunkard?
€ Yes [X NO
B. Bccn a prostitutc, or procured anyonc ror prostiiution?
g Yes [x No
C. Sold or smuggled controlled substances, illegal dnigs, or narcotics?
[] Yes [X No
D. Bccn marricd to more than onc pcrson at ilic samc iime?
g Yes [X No
E. Married somcone in order lo oblain an in'nnigration benefit?
g Yes [x No
F. Helped anyonc to enter, or sry to enter, ilic Unitcd States illegally?
g Yes [X No
G- Gambled illegally or received income rrom illegal garnbling?
[] Yes [x No
11. Failed to support your dependents or to pay alimony?
[] Yes [X No
1. Madc any misreprcsenlation lo ob(ain any public bcncfit in the Unitcd States?
g Yes [X No
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fPart 11. Additional Information (continued)
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31. Havc you ever given any u.s. Govcriiinent official(s) any iiif'oriiiaiioii or documentation that was ralsc.
?
]
€ Yes (X NO
rraudulent, or misleading?
32, Have you ever lied to any u.s. Goveriiment ofTicial to gaiii entry or admission into the United Siaics or to [7 Yes [X NO gain immigration benefils while in the United Stales?
33. Have you ever been rcmovcd, excluded. or deported rrom thc Uniicd Siaies?
[1 Yes [X No
3-1. Have you eiaer been ordered rcmovcd, excluded, or deporled from lhc Uiiited Staies?
[] Yes [X No
35. 14avc you ever been placed in rcmoval, exclusion, rescission, or dcporlaiion proccedings? i
g Yesa [X NO
36. Arcrcmoval,exclusion,rcsciss:on,ordcporiasionproceed:ngs(iiicludiiigtidminislralivelyclosed
[] Yes [X No
proceedings) currenlly peimiiig agaiiist you? 37. Have you ever served in the U.S. Armed Forces'.
[] Yes [X NO
38. Are you currendy a membcr or thc u.s. Amicd Forces'.
g S'es [X No
39. lryou are currently a mcmbcr ofthe u.s. Amed Forces, arc you sclicduled to deploy overseas, including
[] Yes g No
to a vessel, within the next 3 moiiihs? (Refer to the Address Change section wiiliin the Form A'-400 Insiniciions on how to noiif)i U.';C].S if)ioii Ieurn of yoiir deplt;viiient pkms tifier yon file your Forin A'-l00. ) 40. lryouarccurrentlyamembcrortheU.S.AmiedForccs,arcyoiicurrentlystationedoverseas?
€ Yes € NO
41. Havcyoiieverbeencoun-marlialed,adminislralivelyscparalcd,ordisciplined,orhaveyoureceivediiii € Yes [X No othcr than honorable dischargc, wliilc in the u.s. Amied Forccs'?
42. Have you ever been discharged rrom imining or senAce in the u.s. Anncd Forces because you ssere an
[] 'i'es [X No
alien?
43. Have you ever lefl the Unitcd Statcs to avoid being drafted in thc u.s. Amcd Forces'!
[] Yes [x No
4-1. l'lave you ever applied for airy kiiid or cxemption from mililary servicc iii the U.S. Amied Forces?
g Yes [x No
45. l'lave you ever dcsened from slic U.S. Amted Forces?
[] Yes [X No
46. A. Arc you a male who Iived in the Uniled Slales al any Iimc bctwccn your l 8tli and 26th birllmays?
[x Yes [?] NO
(17iis does noz incliide /ivinH in the llnited Stmes as a laufid noniimiiigmnt. )
B. ff "Yes," when did you rcgisscr ror ilie Selective Servicc? l)rovide the infomiation bclow.
)
Da(e Registered (mm-add'y,s6v) ks 4 Sclective Service NumberW
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l'age 17or21
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C. If "Yes," but you did not register wilh the Selcctive Scrvice System and you are: i Still under 26 years or agc, you mtist rcgistcr bcrorc you apply for naturalization, and complete the Selectivc Service information above: OR
2. Now 26 years or agc or older bur yoti did riot rcgistcr with thc Selcctive Servicc, you must attach a statement explaining why you did not rcgisier, and a status iiifomiation lettcr rmm thc Sclective Servicc. Answer Item Numbers 47. - 53. }r you rinswer "No" to nny or lhese questions, include a wriffen explanation on an additional sheet(s) of paper and provide any evidence to supporl your nnssvcr. 47. DO you support the Consiitution and rom ofgovcnimcnt of ihc United Siates?
[X Yes [1 No
48. DoyouunderstandthcfullOat)iorAllcgiancetothcUnitcdStaics?
[X Yes g No
49. Are you ivilling to takc thc full Oatli or Allcgiance to tlic Uiiitcd Statcs?
[X Yes [1 No
50. lr the lasv rcquires it, arc you willing to bear arms on bchalfor thc United Staics?
[x Yes [1 No
51. If the Iaw rcquircs it. arc you willing to perrorm noncombatam scrvices in thc u.s. Armed Forces'!
[X Yes 0 No
52. Ifthe law rcquircs it, arc you willing to perform svork of national imponance undcr civilian direction?
[X Yes g No
NOTF.: Anssser the ncxt question ONLY ir you answcrcd "}aes" to Pnrt 11., Item Numher 4. or Form N-400.
53. At your naturalization ceemony, arc you willing to give up any inhcriicd titlc(s) or order{s) of nobility that 0 Ycs 0 No you have in a foreign country?
l
Pa rt 12. Your Signatu re (USC 15 svill reject yoiir Foriii N-400 if it is not sigiied) Your Statement
l certify. undcr penalty or perjtiry under ilic Iaws or ilic United Statcs or America, that this application, and the evidcnce submiued with it, are al! tnic and corrcci. I authorizc t)ic rclcasc of iiiiy inrorrnation USC IS iiceds zo dctcrminc my eligibility for naturalization.
YourSipnature (1 , ,
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7
Date (inw'tkl/)?)
[
02/17/2014
27
Part 13. Signature and Contact lnl'ormation of the Pcrson Who Prepared This Form, If Other Than the Applicant By my signature, l ccriiry, svtear or afTirm, tinder pcnalty or pcrjtiry, t)iat I prepared iliis rom on behalf or, art thc rcquesi of, and with lhe cxpress consenl or lhe applicant. l completed lhc r0nll based onl7 011 respollscs lhc applicanl provided 10 Inc. Attcr completing the fomi, l rcviewed it and all or the applicaiit's rcsponscs with the applicant, who agrecd with cvcry answer he or shc provided for each question on thc romi and, whcn rcquired, supplied additional inrormation to rcspond to a question on the form.
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Nart ll.- Additional lnformatton (conliimetl)
Page 18 or21
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Part 13. Signature and Contact Im'ormation or the Person Who Prepared This Form, ff Other Than the Applicant (cominued)
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Preparer's Printed Name Family Name (/.asl Naiiie)
Given Name (Fii'si rS'o*iie)
+
Middlc Namc (iftipplicable)
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Preparer's5igna€ure
l Date (riii>ydd',sr)55)
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Preparer's Firm or Organ}zation Name (iJtipplicable)
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Prepyer's Diiytime Phone Number
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Prepnrer's Address Street Number and Name
Ap}. Slc. Flr. Number
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County
Pmvincc or Region (foreigii address niil))
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Country fforeigii uddress oiily)
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State
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Posial Codc (foreigii uddress oidy)
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Preparer's E-mail Address
Preparer's Fax Fax Numbc Nun;ber
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Part 14. Statement of Applicants Who Used an Interpreter NOTE: Ir}ou answered "}'es" 10 Parl 2., Item Nunlbers 11. or 12. or this r0nll :ind during lhe completion orthe r0m used an inierprcier to interpret the questions on thc rom, then you and your imerpreter must complete this section. Applicanl's Statement Each and cvery question and insiniciion on this romi, as we?l as my anssvcr to each qiiesiion, has been read to me by the imcrprcter named below in , a language in svhich l am flucnt.
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(luiigiruge used)
l underslnnd cach and every question and iiislruction on lhis romi, as lranslatcd Io mc by my inlerpretcr, and have provided lrue and corrccl responscs in the language indicatcd above. Your Signature
Diite (mm.'dd/y)yy)
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(irt 14. Statement of Applicants Who Used an Interpreter (continuea)
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Your }merpreter's Slatemenl
l ccriiry thai l am flucni in English and
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l further certify that I liavc read each arid cvcry question and instniction on this rom, as well as thc answer to each qucstion, to this applicant in ihc abovc-mentioned language, and the applicant has informed me that he or she has undcrstood each and cvcry instruction and question on tlic rom, as well as tlic anssver to each question. Interpre€er's Printed Name Faniily Name (liisz Nuiiie)
M idd le Name (if applicuble)
Given Name (First iS'ame)
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Interprcier's Signiimrc
Date (iiiniraddl)r)5)r)
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t Telephone Ntimber
NOTE: Do not complete Parts 15., ] 0., and 17. until the USCIS Officer instructs you to do so at the interview,
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Qart is. Signature at Intcrview I ssvear (tiflirni) and ccriiry under pcnalty or per3ury undcr the lasss of the United Statcs or Amcrica that l know that tlic coiitcnts or . arc lrue this Form N-400. Applicatioii for Naturalization. subscribcd by me- including corrections number I through is tnie and corrcc€. and corrcci. The cvidcncc stibmittcd by mc on numbered pagcs l through Subscribed to and ssvom to (uflirnitpd) bcrorc me
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USCIS Omccr's Prinled Name or Stamp USCIS OfTicer's Signature
Applicant's Signatiire
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Ir}ou answered ")'t'.Y" 10 Pllrt l l., Item Numbers 4. nlld 53-,then )'ou mllst affirfn lhe following b€-ror€: il USCIS Oflicer: which l bave here€orore held: or
l furlher renounce the tille or
7Euide(s)) to which l have here€orore belonged.
l rurther renounce the order or nobility or ( ist or er ol no >i it.v) Applicunl's Signature
Applicant's Printed Nnme
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USCIS Officer's Printed Name
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lPaW 17. Oath ofAllegiance
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If your application is approved, you will bc schcdiilcd ror a public oath ccrcmoiiy at which timc you will bc rcquired to take thc following Oath or Allcgiancc immcdiatcly prior to bccoining a naturalizcd citizcn. By signing bclow you acknowledge your willingness mid ability to take this oath:
l hereby declare on oath, that l absolutely and entircly renounce and abjurc all allegiance and fidclity to any foreign princc, potentate, siaie, or sovereignty, or whom or which l have hcrciorore been a subject or citizcn;
that l will support and dcrcnd tlic Constituiion and laws orthc Unitcd Siatcs or Amcrica against all enemies, roreign and domcstic: that I will bear true faiili and allegiance so the saine; thai l will bear arms on bchalfor the United Statcs wlicn required by t}ie law;
thai l will perrom noncombatant senAce in the Aniicd Forces of the Uniicd States when requircd by the law;
thai I will perrom svork or nritional imponance undcr civilian direction whcn required by thc law; and thai I will take this obligrition rreely, without any mciital reservation or piirposc or evasion, so help tnc God. Applicant's Printed Naine Giiaen Name (Fir.s;l .Ytmsc)
Family Name (Last ,S:ume)
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Middlc Name (f uppJicablc)
Applicant's Signgture
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[DATE] CLIENT NAME
CLIENT ADDRESS
Dear CLIENT NAME:
I hope this Ietter finds you well. I am excited to assist you with your naturalization filing, and am Iooking forward to meeting with you to complete the application. As we discussed on the phone, we will be meeting on [DATE OF MEETING? AT [TIME OF MEETING?. Please note, the meeting will take place at [OFFICE ADDRESS?. [ATTORNEY CAN INCLUDE INFORMATON ABOUT PARKING OR OTHER LOG?STICS IF HELPFUL?. When you come to the meeting please bring the following items with you: [Examples would be taxes, pay stubs, proof of benefits, green card, two passport photos, other relevant paperwork as indicated from case placement file] If you have questions or concerns about this appointment please contact me at [ATTORNEY PHONE NUMBER?. Thank you. Sincerely, [ATTORNEY NAME?
A
September 21, 200(5 CLIENT
Dear CLIENT;
I am writing with regards to the naturalization case that you have open with our office. I have filed your N-400 Applicat'ion for Naturalization with im?migration. Endosed are copies of the application for your reference. We can expect a receipt and a notice of your fingerprint appointment i?n several weeks. After your fingerprinting is comp]ete nothing will happen with the case until immi,o'ration sends us a notice regarding your interview date. At that time l will send you another }etter and scbedule ' you for an appointment to prepare for the interview. REMElS4BER, at the time of your interview we need to present the following items: [] €
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'i7ou can use this time to study for the h?istory/civics test. Typical]y it takes around six months for tbe na'turalization inteThiew, sometime more and sometimes )ess.
Thaxm; you for your attention. P]ease feel free to contact me if you have questions. S in cere? y,
YOURN.A?ME
Enclosure: Copies of 'N-400
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Fee Waiver ;Approyed
Oclober 26 2009
CA5ETYPE ' -' '
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N-400 App1ication For Naiuraization '-APPLICATO;11 NUMBER - "
. RECEIVED DATE
Am PRIORTY DATE.
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APP?]CANT NA?VIE AND MAlljNG ADDRESS
PAY?VIENT INFORMAI?ION:
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C/O CYNTHIA ANDERSON 450 N SYNDICATE ST STE 175
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Single.Application Fee: $0.00
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Eor more int'ormaiion ab6ui the naturalizatiun process aim eligibility rcquiremenM, pleasearead A Guide to Nuturalizazio'n (M-4 j6). USCIS also has a free booklet to hclp study fqr ffie?'naturalization ?test. Ask about Lenrn Ahout,tlie United'Srares.' Quick Civics Lessons when you go te havc >rour fingerprints taken art the Appliciition'Supporl Center.
You can.gel a copy of the Guide, the Quick Civics Lessons book!e:t,,and other'ciyics aim citizenship strid>i inaicrials l'r6i'n the USClS'.ivebsiie.
5wsssv-usffls.gov'). -.You cart aho visit thc.USC:IS wcbsitc ioa!-mu valua51e?iiiramiation about forn'is and filirig instrpciions, and about.general irnmigratioi'i services ar,d benefits.
?f you have additiona! questions abriui possible immiBration benefits .and services, fil'ing'information, m L!SCIS forms, pleasc call the. USCIS Natjonal Customer Servict- Ccnscr (NCSC) art l'-800:375-!i283, ]!: yo?i are hearipg imp,aired,?pleasc call the NCSC TDD at l-8Dp-767-1833. If you have any qiies!ions or commenls regarding this noticc or the. status of your ca
' (800)375.-5283
P. 0. Box 648005
ATTOR'NEY COPY
Lee's Siimmit, MO 64002
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Attenlion: N-400 Natura)ization Applications
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USCIS - National Benefils Center a
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?r an' interview. at your local USCiS .field oriice..
USC]'S Off'ice ?Address:
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Form l-797C (Rev. 01/31/05) N
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arinient iir Hoiiieliiiid Seciiriry ? . Citizansliip and lmmi@rntiori Serv;cr
J-797C, Notice of Actjon
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6
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?ACE
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September 01, 2005 ?
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c/o JOHN C KELLER
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IMMIGRANT LAW CTR OF#rN
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450 NORTH S YNDICATE ST ROOM 175 SA]'NT PAUt MN, 55104 il
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To process your applicarion, INS musr take your fingerprints and have them cleared by the FBI. PLEASE APPEAR AT THE BELO'v'V APPLJCATION S?JPPORT CENTER AT THE DATE. AND allME SPECIFTED. ff y.ou are unable to do so, coinpletc the bo(tom of this notice and, rezrn the entire original no(ice 10 (he address beloiiiii. RESCHEDULING YOUR APPOINTMENT 'u'[LL DELAY YOUR AJ"PLiCATlON. IF YOU FAIL TO APPEAR AS SCHEDULED BELO'l;'l' OR
FAn, TO REQUEST RESCHEDULING, YOU'N APPLICATION 1)VILL BE CONSIDERED ABANDONKD. -==.-l-yp.t,tc-aiiouswp-onr-c?g.n-.-. .. ??.? . ?,?,. it
?.p,x:rx?mp z7*th?op?qyo.zrmnrn ? l ,
mS ST. PAUL
10/21/2005
I%O tJNlVERSffY A'l/E.
10:00 AM
#IO]
ST. PA(JLMN 55104
WHEN YO U G O TO THE APP Ll CAar 10 N S?JPPO RT CEN TER TO HA VE YO UR 'Fl N G ERPRINTS TAKEN, YO U MUST BR?NC.: 1. jHlS AJPO?NTMENT NOTICE and
2- PHOTO IDENTrFlCATION. Naturalization applicants mus( bring their Alicn Registration Card. All otber applicants must bring a paisport, r!ffver's license, pational {D, rniiitary ID, or State-issued photo nD. If you appcar wi(hout proper identification: ' you wil? not be fingerprinted.
PLEASE DBREGARD THIS NOTICE IF YOUR APPL?CATION }IAS ALREAD'l' BEENi GRANTED.
REQUEST FOR RESCHEDULING
Plcase rescbedule rm' aopointrne'nt ror the next available: a. Wednesday ahemoon [] Saturday afJemoon mS cannot ?ranLee the day prererred, but will do so to the ex}en( possible.
Upon receipl of your request, you zvil? be pro'vided a new appoinhnent notice. Please mai.] your reques( to: INS ST. PA(JL 1360 UNIVERSITY AVE. #l03
ST. PAUL &fN 55 !04
If 'iiou have any ouestions re=ardinz this notice. niease call ] -800-3 75-5283 .
REPRESENTATTVE COPY
A!}L?CATIONNUMB?R
1111111!111111111111111!l I Il Il I I I Il I I I I I I I I I I I I I I I I I
L}N"000818204 '?'ARNING!
Due ro limited searing availability?in our lobb?v areax, onl)i pcrsons svho ore necessary to assist with rraruporuition or completing'
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lhefingerprin r work?shecr s)ioukl accnmpnn?v you. Forml?797C lRes'. O?/.",l/05! N
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[DATE] CLIENT ADDRESS Dear Client:
Enclosed please find the notice for you to go get your fingerprints taken. In order to proceed with your application the immigration service needs to take your fingerprints and have them run through the FBI. Your appointment for fingerprinting is scheduled for DATE AND TIME at the Application Support Center located at: [Address for Application Support Center] There is a map attached to this setter for your reference. Keep in mind that the Application Support Center is different from the immigration office in Bloomington. You need to bring the following to your appointment: 1. The original appointment notice (enclosed) 2. Photo identification (license, passport, national ID, etc.) If you cannot attend the appointment as scheduled please contact me immediately to reschedule.
Sincerely,
YOUR NAME Enclosure
Electronic Submission of the
A?R-11, Alien's Change
Department of Homeland Security u.s. Citizenship and Immigration Services Name (Last in CAPS)
o'fAddress Card
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Date ofBirth
Country of Citizenship L
l am in the United States as a:
(Middle Name)
(F irst Narne)
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(City or Post Office)
Present Adr3ress (Street or Rural Route) 11
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MN
Saint Paul
1
(State)
(Zip Code)
55104
7
Years
' (}f the above address is temporary) l expect to remain there
(City or Post Office)
Last .Address ? (Street or Rural Route) '?
L
1
Months
(State)
MN
Saint Paul
(Z,ip Code)
55104
Jwork for or attend schooi at: (Employer's Name or Narne of Schoo1)
(Street Address or Rural Route)
Date of Entry Into U.S.
Port of Entry Into U.S.
Seattle, WA
(State)
(City or Post Office)
(Zip Code)
If not a Pemianent Residenl my stay in the u.s. expires on:
r
[, .Date
Signature
10/06/2010 18:47
AR-11, Alien's Cbange ofAddress Card This card is to be used by all aliens }o report a change of address within ten days of such change. The collection of this information is required by Section 265 of the Immigration and Nationality Act (8 U. s.c. 1305). The data is
used by u.s. Citizenship and lmrnigration Services for statistica? and record purposes and may be furnished to Federal, State, local and foreign law enforcement officials. Failure to report a change of address is punishable by fine or imprisonment andlor removal. ADVISORY: This card is nol evidence of identity, age or status claimed.
This is a paper-copy of your Electronic Fomi AR-l 1, Alien's Change of Address Card. Please do not maU in this form. Retain it for your records only.
Yoiir confirmation number is: COA27 910001304
Jobb Xtllty, Lsq. Eyttu=t Diycroy
Lniort MUlibergity, [aq.
Mtl5hhh Plt'dTty Asmciazt Direcior
Stnioy Anornty
Sbnb StubJmmn, Isq. Stnior Anornty
Cynlh5s Abdtrhows
Progrcrm Director
!%mui 3orgtxihtn F)oru, Eaq.
Tsmmy Viutgma Qffice Manngtr
StaflMtornty )uthlttn X)oz [aq. Smfi Alzorney
Xstblcen Lobmsr E?, [sq.
Dtvelopmens Associaie
Ans l?Jhs Pt6m,][.aqSiofl Auornty
lrmnigrant Law Center of Minnesota
Psfiht Ynng
450 Nortb Syndicate Sheel a Suiie 1 75 a Saint Pau? a Minnesota a 55 ?04
LtgplAsxismril
Tel: 65].64].?0?? a ?.800-223.?368 a Fax: 65].64].??3] www-i?cm.org a E-mai}:
[email protected]
Mo?a ?htve Caybajaj Rtctptioniss
' Mjcstla SchnnemmniEiq. AmeriCorps'QST4Attorriey Anbt App)tbmum, Eaq. AmeriCo'rp:' V?STA Trim Vmng AmeriCorps" J'lSTA
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u.s. Citizenship and Immigration Services Naliona? Benefits Cenler P.0. Box 648005
Lee's Summil, MO 64002
Attn: N-400 Natura?ization App?ications A m : RE:
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Dear Sir/Madam:
Our office represems Ms.?in her app?ication fo.r natura?ization. Ms. '? has rece'nt?y mqved. Sbe now resides at tbe fo??owing add?ress: !? Sainl Pau?, MN 55]04
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P]ease updale your records to reflect ber new address. Thank you for your atlentionSinceye]y,
!u Micaela Schuneman
AmeriCorps*V]STA Aftomey Cc:
A nonprofit organixntion strving immigrms rod rejvget jamilie:i and in&vidual:i in immigymiop mmrers ihrovgho'ut Minntsoza
l-797C, Notice of Action
u.s. Citizenship and ?mmigration S,P ;ces l
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12901 METRO DR?VE lBLOOMmGTON MN'55425-
REPRESENTATTVE COPY
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N-659, Naturalization
Department ofHomeJand Security
Interview Document Check List
U.S. Citizenship and Immigration Services
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Bring the original and a photocopy of the applicable items listed below to your naturalization interview. Any document in a foreign ?anguage must be accompanied by an English language translation. The translator must certify tbat he or she is competent to trans?ate and that the translation is accurate.
You must be on time for your interview. Late arriva? may result in the need to rescbedule your interview. Rescheduling can cause significant delays in the processing of your appJication. Bring all the required documents to avoid delays in processing your case. This is a general iheck list and since each case is unique, you may be required to submit additional documentation.
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1. You must be proper}y attired and bring: A. Your Permanept Resident Card (previously know? as "Alien Registration Cgd" or "Green Card"); and a
B. A- government issued pboto identification; aad 'C. All passports and travel documents (including expired and current) issued to you by any government. D. Although not required, it is recommended Uhat you bring two additional passport-style photos (2 "x2"). The photos must be in color with full face, frontal view on a white to off-white background. Head beight must measure l " to 1 3/8 " from top of hair to bottom of chin, and eye height is between l l/8" to l 3/8" from bottom of photo. For additional specifications, refer to
. 2. If your cutrent name is differ'ent .than. the name on your Permanent Resident Card, bring: The document that lega?ly changed your name (e.g., marriage license, divorce decree, court docurnent). 3. If you are applying for naturalization on the basis of marriage to a U.S. citizen, bring: A. Proof that yom spouse has been a u.s. citizen for at least the past three years (birth certificate, naturalization certificate, certificate of citizenship, your spouse's valid U.S. passport, or Form FS=240, Report of Birtb Abroad of a Citizen of the United States of America); and B. Your current marriage certificate registered by a civil autbority; and C. Proof of the termination of all previous marriages for both you and your spouse (divorce decree, death certificate, etc, registered by a civil authority); and D. An original Internal Revenue Service (IRS) Form 1722 listing tax infomnation for the past three years (cal? IRS tol$-free at l-800-829-1040), or copies of the income tax forms you filed for tbe past three years; and E. Proof of marital union as well as proof of residence; and
D. Certified copies of birth cer(ificates of all your children born in tbe United States. 4. If you have ever been in the U.S. nxuitary, or are applying based on muitary service (see sections 328 and 329 of tbe INA), and have not previously submitted the two forms listed below with your Form NAOO, bring: A. An original Form NA26, Request for Certification of Military or Naval Service; and B. An original Form G-325B, Biographic lnfomation. s. If you bave taken a trip outside the Unjted States that lasted for six months or mote since becoming a Permanent Resident, bring:
A. Evidence sbowing that you did not abandon yom residence or terminate your employment in the United States nor abandon your 'u.s. abode; and (Continued on Next Page)
Form N-659 (Rev. [0/22/07)N
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B. An original IRS 1722 !etter (call IRS toll-free at 1-800-829-1040), listing tax information for the past five years (or for the past three years) if you are applying on the basis of marriage to a u.s. citizen.
6. If you have taken a dependent spouse or children and have been ordered to provide financial support, bring: A. Copies of the court or government order to provide finartcial support; and
B. Evidence that you have complied with the court or govermnent order (cancelled checks, money order receipts, a court or agency printout of chi]d support payments, or evidence of wage gamishments).
T. If you have ever been arrested or detained by any law enforcement officer for any reason and no charges were filed, bring: ,An official, certified statement from the arresting agency or app?icabie court indicating that no charges were filed.
8. If you have ever.l?een artested or detained by any law enforcement officer for any reason and charges were filed, bring: An original or certified copy of the arrest record(s) and the complete court disposition for each incident (dismissa) order, convictiori record, or a,cquitta] order).
9- If you have been convicted or placed in an alternative sentencing program or rehabilitative program, bring: A. The sentencing record for each inciaent; and
B. Evidenee that you completed yom sentense, such as probation record, parole record, or evidence that yo4 completed an alternative program or rebabilitative program. Copies must be certified copies from the issuing agency.
10. Ifrecords, you havebring: eve;'had any arrest or conviction vacated, set aside, sealed, expunged, or otherwise removed from your An original or certified copy of the court order vacating, setting aside, sea?ing, expunging, or otherwise removing the arrest or conviction. ? NOTE: Unless a traffic incident was alcohol or drug related or serious personal injury to another person occurred, you do not' need to subrnil 4ogumentation for traffic fines and incidents thai did not involve an actual arrest if the only penalty was a fine of
less than $500 and/or points on your driver's license.
14. If you have any Federal, State, or local taxes that are overdue, bring:
A. A 6ignqd agreement from tbe IRS, State, or local tax office showing that you have filed a tax return and have arranged to pay tbe taxes you 6we; and
B. Documentation from the nRS, State, or local tax office showing tl)e current status of your repayment program.
12. If you are applying for a disability exception to the testing requirement and have not submitted Form N-648, bring: An original Form N-648, Medica? Certification for Disability Exceptions, completed by a licensed medical doctor, licensed clinica? psycho?ogist, or licensed doetor of osteopathy.
13. If registered wjth the Selective Service, bring proof of such. lfyou did not register with the Selective Service and you are (1) ma?e, (2) over 26 years oJd, (3) were born on or after January ], l 960, and (4) were a Permanent Resident between the ages of 18 and 26 when you failed to yegister, explain your faUure to register and bring:
A "Status hiforrnation Letler" from the Selective Service. (Cal] the Selective Service at 1-847-688-6888 for more information.) ?4. if you are requesting expeditious naturalization under sectiori 319(b) ofthe INA through military service, bring: The U.S. citizen's trave? orders that inc?ude the name of the a?ien spouse and establisb that the overseas assignment wil? end no }ess than 12 months beyon4 the date of the naturalization interview.
G ?' Ll.S. GOVERNMENT PRINTING OFFICE. >ooe-n:r-aasrs>ozs
Fomi N-659 (Rev. O?/22/07)N Page 2
DATE
CLIENT NAME AND ADDRESS
Dear CLIENT;
I hope this letter firids you well. I am writing with regards to the naturalization case that you have open with our office.
I have attached a copy of the interview notice from immigration. Your naturalization interview is scheduled for TIME AND DATE.
In order to prepare. for the i?nterview I have scheduled an appointment for you in my office for '-JME =AJ4 lThA'l'iK.
At the time of your appointment with me we, will review your application again, give you an orientation about the immi gration interview, answer any questions that you have and pract:ice. for the test. Please come prepared.
If you need to change the time of your' appointment with Ine please feel free to call me. Thank you for your attention. Sincerely,
YOUR NAME
Enclosure: Copy of Appointment Letter
}l-9. Department of Homeland Security . l Metro Drive, Suite ] 00
Bloomington, ]'i4N 55425
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Ox?i, 1/7/2010 you were interviewed by USCIS officer Howe You passed the tests of Eng]ish and U.S. l?iistory and government.
You passed tl'ie test of U.S. history and government and the Englisli )anguage requirements was waived. X USCIS has accepted your request for a Disability Exception. You are exempted from the requirements to demonstrate Eng]isli language and/or a knowledge of u.s. history and government. Yoii will be given ano.ther opportunity to be tested on your ability to 'i'ou will be given another opportunity to be tested 011 your knowledge of U.S. history arid governn'ient. P?ease fo?low the instructions on Form N-14.
USCjS wil) send you a written decision about your application. You did not pass the second and final test of your You wi?l not be reschedu?ed for another interview for this Form N-400. USCIS will send you a written decision about your application. a)
X Congratulations! Your app?ication is recommended for approval. At this time it appears you have established your eligibility for naturalization. If fina) approva? is granted, you wi?] be notified wl'ien and where to report for the Oath Ceremony.
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A decision cannot yet be made about your application. X It is very important that you: X Notify USCjS if you change your address. X Come. to any schedu?ed interview. X Submit all requested documents. X Send any questions about this application to the officer name above. Include your fu)] name, Alien X Registration Number (A#) and a coP':}l of this pa.per. X Go to any Oath Ceremon)i that you are scheduled to attend. X Notify USCIS as soon as possi51e iii writiiig if you carinot come to any schedu)ed iritervie.w or X Oath Ceremony. Iiiclude a cop)i of this papei' arid a cop,y of the scheduling notice.
Note: Please be advised that under section 336 of the lmmigraiion and Nationality AC! you have the right to request a hearing before an ? i.minigraiion officer if your application is denied, or before the u.s. district court if USCIS had not made a detemiination on your application within 120 days of the date ofyour examination. WWW.uS€lS.eo€n'
DATE
CLIENT NAME AND ADDRESS Dear CLIENT
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I hope this letter find you well. I am writffig with regarrls to the naturalization case that you have open witb our office.
Attached please find tne notice for your swearing in ceremony. It is scheduled for DATE at TIME at the location that appears on the notice. I have enclosed a map nf the lncati Q71 5rr sy.;;,reference.
Before the ceremony you need to complete information on the back of the notice. These are some of the same questions that you answe:red at the time of your interview at the immigration
office. However, the questions th;at you will answer ?IOW apj}y only to the period Q7' ti'tne between
the imerview and the ceremor4v. If notbing has changed since the immigration interview you can answer "no" to all the questions. Please use black ink If you have traveled, been anested or stopped by the police since the time of your i?mmigration interview you should contact me before the oath ceremony. Also, if you have questions or c6naerns prior to tbe iriterview do not hesitate to cal.l me.
On the day of the ceremony you should: o
Bring the Oath Notice with the questions on the reverse answered in black ink
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Bring yom resident alie:n card or "green card"
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Wear appropriate clothi?ng for the event (it is somewhat formal with a judge, photo,o'raphs and hundreds of people. You should not wear a hat or jean.s)
l will keep your case open in our office until you send me a cop5i ofiyour naturalization certificate. You should review the certificate carefully for any errors.
Thank you for your attention. And again, congratulations! Sincerely, 'i"OUR NA]v!E anTLE
Enclosures: Oath notice
Map
}ie)iarrm'e.nt of Home};iric! Securiria
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Eorm N-445, NojThce o'r NaxuraFzaticih Oath Ce..ve'mon3'
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c/o CYNTHIA ANDERSON
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You ar e llEreb)' llo'LLfied to' a ppe.ar for a J'Qaturalization Oatr+ Cerem on ;' ori : Wednesdaii. Aoril 7 2010
US DISTRICT COURT OF MI'NNESOTA
at:
3 ?6 NORTH ROBERT STREET
S,'JNT PAUL, MN 55101
FEDERAL BUILDING AND COUR'n-?OUSE, ROOM 1, GATE ]
Pleas= rcport prompt:ly at
1:00 PM
THE CEREMOA'l" i4'J?LL BEGLI%7 AT : 2:00 PM
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You mus? bring t}'ie followiiig waith yriu:
x@ Tnis l:tLr, wi.q -yi THE ?[ffiSnQl4S o+%- P-AGE 2 ?A?]4S'sJy7F,P,ED TrTE C)R PP,INT A'i'qs'>.7EP,S P.%BLACK INK.
X@ P?anzt Resia':nt C.ard.
xm Re:ntrv P'?it or R:mgee Trav:i Do:um:rii-
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-%'it Lrnrrug?raliori docurn:nts yo'u rrsal.,? h.a'sre . l] M tn: riatur:aiiza'tiori app'i?i:a'uon l!?' ori 'ri:maii cl5 'vour =.aiir:i % :iarehj. 'rirmg siour ci{a Qc'niiai'.'z'; @ Ofl'i=s'.
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.L?' you 'aani?ioi corri = I(!' in?rs c:i'ernori y, r:'curri 'i-n'is rior=: irra'ri :alaEl'%' .a.nci- stat= sv'n'y ?'vou cannot 'apli'eai. JJI. su:?? s;as:,. 'vov viill b= s=in anoTh:i noli= O'F =remorii.: art ;i iat:i aai::. ?J- 011 ma
? namraaiizatio.a pi.'o::ss..
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In com:clion with yo'ur applicalion for natua-alizatio; p5:as: answer :aa'i of tn: qu:stions by chedcing "?
actions since the dat: ;iou v=r= fyst interviewed on your -kpprsasiori for Naturai
an ytl?img that happened brfore tl?i: intev>ew:.
Aftaar 'srou FJ'Ve answereai rvcr;a q'aestii5ri.. 'sig; -yci'ar 'aarne. anJ .til2 v th= aa't: aria pla:: cf siming, ai.ia pro'vide ?your c'urrent address.
You 'niust bring this completed questionnair= witn.n yoq to tbe. oatb ceremon;i, as w:n as th: documents indicated ori th: 7Cnl TJ)
C i tiz * ns -'and l?rni-rupauon Servzc:s at tne? oat???ce;e,@on) 'l-ou ma'1 front and givt tnem to tne empiov= of the U?S IZitiz:nship
'oe -qu;tion eA- 'FuM'e'r on yHar 'ansivers at 'That-tim-e,-'
A?FTER the date !!70U were first interviewed on your .Ap.p)icat.ion for Naturaiization, ANSWERS
Form N-400: 1.
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H;rve you married, or be:n widowed, .peparated or 6'rvorced', af "Y'c,." pleas:= 'Dnng aocumented 'p'soof of marriage? death. sffiaration or divcirc:,:r
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?dav= you tr,ive?ed outs.id.= the United Stata?
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Have vou ?a'iowingiy co?tted .any ?: or offense, for wIni:h ;iou hav: not 'o=n arrestexl":
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Have you b=n anester?, aited,, charged, ?m6icted, conv'icted, f.in:d or irnprysonea for br=ak?mg -or vio)aiin g an>i law or orainance, u'icJuding traffic violations "! Hrnie. you .lo*ffl 'any organizabon, includini the C.omrnunist Party, or b:come
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associated or aomie:ted tb:rewith in any wa?iQ:
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Have yon claim:d exzpt.ion from military service":
6.. g.Yes
[lNo €Ncl
Has ther€ aae,i any charige in your willingness to bear arms on b:half of tn=
'[?5mted Si?aLs', to perform rion-combatant szzice. in the arrn.ed forcs of tb= United Stzit=sa; tc p=rfom svr>rk of riational imporlirice unr!.e:r civi?ian airectton, if the las*; requma it? 8
Have you practiced po}ygamy, rx:effied income ffom il]ega] gambiing, ?ri:m a prostitut':, pro:ured an;ione for pros tj'hjtion or be,n mizo'lved in mi)r oth,r unlawrffil commerc.iaiiz:d vice, :ncouraged or help'd any alien tc smer th= UriiteJ Stai:s ill=ga}ly, iuicitJ;i trafficked in dru': or fflarijuana, iven any fals: t=st'rnony to obtain immigration benefits. or b=n a habitua? drunkard?
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[)Yes?No
8.
[]'r'=5a '[] NO
l ceriif?1: tnat eaTh of the answers shosvn abov: wge made 'bsr m: or at my dnectxori, and :fnat they are tru: and corr=t aE of the evt=.of my na'iui-aiization oatn cqernony. ' 'Signed at
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(Full A?:.ss an6 fip Coa=;i
0 UR A UTHO R?T' .ior con:c'6on of .the infomiatigB s=m'stea oriForm 'N-44 s v c?e6 in !'c€ r:trv 101 i'.f3, 3i3, 316, 332, 33 5BylL-: 336 of
the ]?gration and NatianaEtsi Aci (8 o-sr:..? 1101 ?Cf.i, ] 427, 1 443., ] us ? i a.ay> Si?ssion of th= inaomiation.is volun?. The pffiopa?
purooses for r=au=sr? L irif?at'on ar:.to embl@ .A6juaica'6anr. C')fnc:rs of th: t!.S. Citiz-z:rmp ? ?gration S:rvi c:s to a:ter'r,: art iKcani s eM@biii'l for natur?tion. i n: irif?a6on reqxsted may,.as .a matter of routir= us:, ?ri: aisc?iose& i6 riaturaiatian co'iuts and tc
otjier f eaeral m't=, local or f.ar:ip law ?gcernern ? reguiatory xw6=s, .th: Dqanrnem of D=r:ns:, irrciu?g. mr>i corrrpgerd t?-iez=a', S:iective S:rvic: Svstem rirp?rnt cf ?Sia't:, D:parttrient or Treasuni, D:parmi:rd of Transpomtiar?, C=mra3 ]?mllig:nc: A.gency, ln;rpol anr5
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mg.-of aru,applicatios:i ixx.mS
ing h: .zom s: i*sp srq'? Li .4 a :mrlke. ?
inforrrmtion required by the U.S. Cifi=nship and lmmi5gation Ser.aic:s so carry our ia...e. runcti ons. lmaomrancn soiicite6 wThch inai cates h 1!iiarion t.r poten6a? vio? a'6 on cf?aw, wnetjm civ'i'i, (y;m;nql. ci! re'g'talr; in nat'u?ei rriBy '?Lle rserrea as a !0fiffi la i0 $.-+ a=yvcp'mate .s>35Ql,-.
wh:tn:r r=i< su'e, xoci (X far:isz c?gea w?tn tn= x=spr:bi'tiiiity or inv:s=g a?, ?oi'? c'r 'orosecutis'ig, such Vl0ffl'6'on'. Fai}ur:' i(r
p'rcivi d: al] ar an:it or th'= s=qu=s'ea iniorrnatiori may resul'i in a derna] of tn:" application k naturamaff art
'TH.E P UBL} C REFORTIN G BURDEN forti's coll:ctian of informaffc?n is :stimateo .tci aveyao: ] Ci minutes?p:: r:spon's:, ir+ciu? jj.ff. ?=. fcT Te'Jle? ffls T]'uctl 0115, sealckuns! e)'Jshng datfl scnnc es, 'gathenn,' :ana .maln?, lne dat' n:ede (! and cornpl€ tlng ana T:'VieT'i'?ng . tjl: col?ectirn of inforrnatiori S:na comrn:re r:gm% this atiur? :es?aie oi ?: otns aspe=r cif tnis inf?ation collectiwi, inc?4 suggesnors ior redu..? tr'iis ?r:imr:,eri to: ti.S. G?n-snip arfa irrsm'gration Sen6ces, P.egulasory Mmug=m=rii Divisior: 11 ] Massachusetrs avenu=, ]a?!.W ., 'A'as?or,? DC :?052g. Fortn N-4-!!5 I:J<-El' airarpiOs>ks ?ag= t
April 22, 2013 CLIENT NAME CLIENT ADDRESS Dear CLIENT NAME:
I hope this letter finds you well. Congratulations on becoming a U.S. citizen! Since your case has been approved and you have received your naturalization certificate, I will be closing your case in our office. Please send to me a copy of your naturalization certificate for my records.
There are a few things you should know about your new status in the U.S.: 1. You will never mn the risk of deportation, as long as your naturalization application was not fraudulent in any way.
2. You have more rights to file family petitions. You can irnrnigrate your married children, your parents, and your siblings. Petitions for spouses or umnarried children are usually faster.
3.
You have the right and the responsibility to vote in elections. If you would like more information about registering to vote, the candidates, or the democratic system, you can contact the League of Women Voters: LWV of Minnesota
550 Rice Street, Suite 201 Saint Paul, MN 55103-2144 Phone: 651-224-5445 Fax: 651-290-2145
E-mail: info(,lwvmn.org
http://www.lwvmn.org
4.
You can apply for a U.S. passport. You can find the application on the internet or at some post offices.
s.
Your children under the age of 18 who are Lawful Permanent Residents will automatically become U.S. citizens. You should file the necessary paperwork with immigration. If you need help you can contact our office.
With this letter, your case with is officially closed. It has been a pleasure working with you. If you have additional immigration-related legal cases that you need assistance with please contact the Irnrnigrant Law Center of Minnesota.
As you know, the ILCM office serves low-income clients. ILCM depends in part on donations to continue providing services to new clients. There is no obligation for you to give, but ILCM asks for your support if you are able to help the office continue providing legal services to the immigrant cormnunity in need. You can give online at www.ilcm.org or send a check or money order, made out to ?ILCM,? directly to the Irmnigrant Law Center of Minnesota offices. Every donation, no matter what size, is extremely helpful. Again, congratulations and I wish you the best!
Sincerely, [Attorney Narne]
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